AUTHORIZATION FORM

 
Full Name : Province :
Street : Postal Code :
City : Passport/ID :
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Dear Mr. Vickky, (NEW BOSS FASHION )

I, HERE BY AUTHORIZE BOBBY TO PROCEED WITH MY ORDER AS MENTIONED ABOVE AND TO DEBIT THE SUM OF FROM MY CREDIT CARD SPECIFIED BELOW.

AMERICAN EXPRESS MASTER CARD VISA CARD

CREDIT CARD NUMBER:

EXPIRY DATE : (DD/MM/YY)

FOR AMERICAN EXPRESS PLEASE MENTION THE FOUR DIGIT NUMBER APPEARING ON THE ENTER RIGHT HAND CORNER OF YOUR CARD TO PROCESS

(PLEASE FAX / MAIL OR EMAIL THIS LETTER TO Vickky)

TEL : +(662) 2536969 FAX : +(662) 2514439

E-MAIL : [email protected]

Please note :- We reserve the rights to treat all information provided as strictly confidential and intended for one single use only.


 
 
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